Do you have trauma or PTSD?

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1:34Kimberley Wilson:Hello and welcome. I'm Kimberley Wilson. I'm a counselling psychologist and this is Complex. The psychology podcast helping you chart a clearer course through the hills and valleys of mental health information. In today's episode, I'm exploring trauma. It is a word that is everywhere right now, but certainly from my perspective, trauma is also one of the most misunderstood and misused words in the mental health space. People use it when talking about being stuck in a long queue on a hot day, for example. But in this episode, we're talking about the kind of experiences that can have profound and lasting effects on how you see the world and yourself.

2:30Kimberley Wilson:One in three adults in England say they have experienced at least one major traumatic event in their lifetime, something that made them fear for their own life or the lives of the people they love. But that's not to say that they will experience long-term traumatic reactions. In fact, the research says that in most people, the symptoms resolve within a month. but of course in some cases they can persist. So in this episode we're going to try to get to grips with a loaded term that a lot of us use a lot of the time and to try to give it some context so that we can understand it better. As usual I've got a great guest to help me and together we'll hear a listener's dilemma.

3:17Kimberley Wilson:So let me be your guide from the dizzying mirror maze of misinformation to the signposted walking trail of understanding.

3:31Kimberley Wilson:And I'm so pleased that clinical psychologist Dr Ronald Doddsrow is joining me in the studio. Welcome to Complex, Ron. Thank you for having me. So Ron, tell us what it is that you do. All right, so I'm a clinical psychologist and I specialize in trauma and PTSD. so I work with young people in particular who have experienced community violence it's often synonymous with youth violence gang violence but they've got to a point in their lives where they no longer want that lifestyle and almost want to become what they call a civilian so they're ready to reintegrate into society and examples might be a young person I'm working with who's just about to have a baby and he's thinking about the ramifications on his child I have another young person I'm working with who wants to go to uni and understands that that lifestyle can't go hand in hand.

4:20Kimberley Wilson:The image that comes up when you describe that is of these two worlds and of experiencing yourself on one side of the glass and wondering what life is like on the other side of the glass and how you make that transition across to civilian life. Yeah, it's a really difficult process. I work with a cohort who, by virtue of being exposed to that lifestyle, have been exposed to very traumatic events. And my role is about assisting them to process some of that stuff. And how did you get into this work? Oh, great question. So I grew up at a time where South London had quite horrific levels of community violence.

5:02So I was very much exposed to it somewhat at a young age. And I was quite curious about the different ways young people were having to respond to situations, which I now can formulate as trauma responses.

5:14Kimberley Wilson:Okay, so you were like looking at friends and things? Very much so, yeah. So I was looking at friends, even family members, if I'm honest, and thinking about their stark changes in their behaviour, in the way that they were thinking about safety, the way that they were viewing everybody else around them. And just the curiosity on that kind of took me down a path of psychology. It feels like you might be the perfect person for us to be getting to grips with this very difficult topic. So thank you.

5:44Kimberley Wilson:so at this point in the episode as listeners will know i always start with a definition and that feels particularly necessary with a topic like trauma from a psychological perspective how would we define trauma trauma is a response it's a physical a psychological and emotional response to a distressing situation that overwhelms a person's ability to cope. And for me, overwhelm is the most important word here, because you can be exposed to a situation and be uncomfortable. You can show some level of distress, but it doesn't overwhelm your capacity to cope with a situation. And another term that we hear a lot is post-traumatic stress disorder or PTSD.

6:28Kimberley Wilson:And over one in 20 adults in England are living with PTSD. So could you clarify the difference for us? The first big distinction is PTSD is a diagnosis. So unresolved trauma, untreated trauma can contribute to the development of mental health disorders generally, and one of them being post-traumatic stress disorder, PTSD. And PTSD ultimately is a diagnosis given when certain criteria are met based on a collection of cognitive, behavioural, emotional responses to a traumatic event. So you can't be diagnosed with trauma, but you can be diagnosed with a penis. Exactly, exactly that. Thank you. I think that's really clear.

7:09Kimberley Wilson:That's really helpful.

7:15Kimberley Wilson:Now I'd like to share a listener's story with you. As you may know, people email us their dilemmas, their stories, their questions and experiences. So thank you to everybody who does that. Please keep them coming in. And I'm going to call this person Gabriella to protect her identity. Gabriella says, I love this podcast and I found it really useful. Thank you very much, Gabriella. I was wondering if you could look at PTSD. I had always assumed that this was something that people got from demonstrably traumatic events like a terrible car crash or sexual or domestic abuse or experiences of war. It was only recently that I learned that this term can be applied also to people who have experienced events like psychological bullying at school or school exclusion and humiliation.

8:02Kimberley Wilson:It would be amazing to have a deep dive into what this looks like, feels like, the impact and how it might be resolved. So thank you, Gabriella. This is a very interesting and pertinent question for us today. Ron, Gabriela asked about, you know, impact and resolution, which we will get to later on in the episode. And I suppose it's worth saying also that she asked specifically about PTSD, but we're going to be talking about trauma through that kind of broader lens. So with that, let's get into the complexity.

8:39Kimberley Wilson:so Ron what might trauma look and feel like so a typical trauma response is hypervigilance where the individual might be scanning their environment constantly detecting threats you might find people who have problems with their concentration actually you're having conversations with them and you can see them really struggling to understand what you're speaking about sleep disturbance so people really struggling to fall asleep and stay asleep there are loads but those tend to be the primary ones that for me would be quite a helpful indicator that somebody's struggling with trauma and what causes trauma i would say anything that overwhelms i'm using that word again overwhelms the nervous system's capacity to cope can be traumatic and can cause trauma yes and that brings into question the kind of developmental age or phase when that person experiences the trauma you know so an event that you experience in childhood would be much more overwhelming than if the same event happened to you in your 20s agreed agreed and that's because the parts of the brain that are often implicated within trauma ptsd it's not well equipped to deal with that trauma which is often why kids will dissociate when their minds are taking them to somewhere safe.

9:58Kimberley Wilson:Exactly and we did an episode on dissociation and we thought about how it can be the mind's only way of kind of surviving something that feels utterly overwhelming and confusing and chaotic and you mentioned areas of the brain and how they relate to traumatic experiences. What is happening in the brain when we're experiencing or processing trauma? A lot. so the three areas of the brain that are often implicated are the amygdala the hippocampus and the prefrontal cortex so the amygdala is a part of the brain that detects threats and that can be actual or perceived threat and when the amygdala is stimulated it activates the stress response which is our flight freeze response so the amygdala is like the alarm system the brain it's looking out love that yes and it's it sees something that's threatening and it switches on we respond to it quite quickly before kind of rationally we can even know that we've responded to the situation.

10:53So the amygdala, when people have been exposed to trauma, it becomes really sensitive where people are detecting threats everywhere, which then means their stress response is being continuously activated. And that can have huge ramifications on people's physical health, actually, that overload of cortisol in the body.

11:09Kimberley Wilson:Yeah. So it can be a vicious cycle where you've got this now sensitized amygdala. It's almost like the alarm never stops. And the prefrontal cortex, that front part of your brain, which we consider to be the kind of decision-making, planning, solution-finding, contextualizing part of the brain that kind of puts the brakes on the amygdala when they're working well. What's happening to the PFC during trauma? So when somebody is experiencing high levels of trauma or has a diagnosis of PTSD, we've actually noticed that the prefrontal cortex becomes smaller, which then means it's easier for the amygdala to override it so this is where we will notice people struggling with impulse control they will be engaging in more reckless and self-destructive behaviors they might be engaging in more substance use and that's because the prefrontal cortex doesn't have the same capacity to think about the heightened level of rational thinking and making appropriate choices yes or the long-term ramifications of the behaviors and then the last area you mentioned the hippocampus the seat of memory how is memory involved yeah i often call it the memory keeper so the hippocampus is where we store and retrieve memories and it also helps us to differentiate time so the past and present when somebody is experiencing heightened levels of trauma or meets threshold for diagnosis of ptsd the hippocampus it shrinks and this can lead to things like dissociative amnesia where a lot of people struggle to remember significant aspects of the traumatic event we see it in the therapy room where people will say i don't remember whole chunks of my life somebody told me this somebody told me this is how i responded or this is what i did and people like i really cannot remember that and again we might consider that part of the survival response that the brain has locked that away exactly because it would be overwhelming and too much for the person to cope with and you mentioned when this cortisol is sloshing around the body with this very, very sensitized amygdala that it can have physical effects.

13:12Kimberley Wilson:What physical effects do we see? So I guess when I'm thinking about the fight-or-flight response, we're thinking more so around the heart racing, the sweating, the shortness of breath. But I'm also talking about longer-term effects. So there's been lots of research talking about the issues around cardiovascular health, actually, and quite detrimental physical health issues. Yeah, We see people with increased risk of cardiovascular disease, autoimmune conditions, and just poorer health in general. So it's really important that we understand this is a full body response. It's not all in the head.

13:43Yes, when we are thinking about trauma, people often locate it in the mind. But are we listening to our bodies?

13:49Kimberley Wilson:And do we know how to listen? If you don't assume, for example, that your gastric issues or that back pain that you've had for a long time or that inflammatory condition that suddenly has flared up is linked to something traumatic, then you might not make those associations. 100%. And why is it that two people can witness or experience the same traumatic event but have very different experiences or responses to it? So it's less about the traumatic event itself and more about the subjective interpretation surrounding that event. So at face value, a traumatic event is a traumatic event. But has the person been exposed to harm before?

14:36Particularly within childhood development. Do they have access to practical and emotional resources? Do they have people around them that helps them keep them safe ultimately? And those things can often be contributing factors that can shape how an individual will view that traumatic event.

14:53Kimberley Wilson:And I think that's really important to hear because I think if you've experienced something traumatic, then you might think, well, this is going to be something that leaves me wounded for a long time. And I think there's something quite important to hear that that's not necessarily the case. Agreed, agreed. So lots of people will be exposed to that traumatic event and will develop some level of trauma symptoms. But for many people, with time, with the right support, those trauma responses kind of subside over time. And I guess on the other side of that question is, actually, sometimes you don't even need to have experienced something directly for it to have an impact on you.

15:38So I often think about people's exposure to trauma in five ways. You mentioned directly experiencing the traumatic event. You can have somebody witnessing the traumatic event occurring to somebody else. You can learn about the traumatic event happening to usually a close family member or a close friend. You can be experiencing extreme or repeated exposure to aversive details of the traumatic event. So that's vicarious trauma. and this is where I'm thinking about psychologists, therapists, first responders, social workers, youth workers, people who by virtue of their work will be very close to listening to all of that trauma and can often be absorbing that pain and suffering.

16:20And then the fifth one is generational trauma. Trauma passes down through families. So when I work with a parent who has severe trauma, they might not have the language for that experience but the impact of it might relate to how they respond to their children. It might be about how they create or don't create an emotional environment within the home. It might be how they communicate trust and safety to their children. Children absorb all of this information.

16:46Kimberley Wilson:It's one of the reasons that therapists do want to know about your parents and your grandparents and sometimes even further back. I think also in certain communities, very reasonable responses can be misinterpreted as pathological. So, for example, black people might describe feeling surveilled or not trusted. And without a kind of awareness or cultural nuance, that can be diagnosed as paranoia. without understanding that there is a kind of community-based trauma around experiences. Perhaps may not have happened to that person, but have happened kind of generations before. I think the cultural nuance is often the thing that's being missed.

17:34Kimberley Wilson:I am thinking about populations that have been in conflict for a long time, where there are traumatized individuals on both sides, and the other group's trauma is invalidated. But also I wonder if it's misunderstood or misinterpreted. I work with a population who they are often at loggerheads with the police system. And a lot of the work that I've been doing quite recently is trying to assist the police system to think about their own officers being somewhat traumatized by virtue of being first responders which heightens the likelihood of them misinterpreting other people's trauma responses. And that's where the danger can often lie.

18:24Kimberley Wilson:And what might that misinterpretation look like, for example? So there might be a young person who is, I don't know, being quite hypervigilant. And visually, that looks like being on edge, scanning the environment. The police might think he looks quite shifty. He's being suspicious. He's being suspicious. And so that trauma response has now been somewhat villainized and interpreted through a particular lens and a bias and an individual might see that potential threat in the police and run away. That being a trauma response. And the police again might misinterpret that as this person is running away because they're suspicious or they've done something bad.

19:03And this isn't even just about the police. There is a big, big issue around the pathologizing and the misdiagnosis of trauma responses. And it isn't just about an individual. a whole system can be traumatized in itself which trickles down to the individuals that work within it.

19:23Kimberley Wilson:Okay Ron so let's see if we can offer the listeners a little bit of context to some of the things that we've been discussing and put this topic onto a scale which I think is particularly useful for a word like trauma. So when does our response to a bad aversive event tip into what we might call trauma? So for me, one of the big, big facets of it is an individual's sense of self and identity. So lots of people who are struggling with trauma will have issues around worthlessness, shame, failure. They would often actually feel quite damaged or defective as a result of exposure to that traumatic event so for me already we've shifted quite quickly from an uncomfortable or an unsafe situation to trauma we're also thinking about people's sense of safety how safe do they feel in their own skin their own internal body versus how are they viewing safety amongst other people we're thinking about emotional regulation or people's struggling to kind of regulate their emotions as a result of that traumatic event but also how they respond to other people.

20:33Kimberley Wilson:Yes. I'm thinking, for example, of when someone has their bag snatched and an understandable, completely reasonable response might be that they feel frightened, confused, let down, threatened, scared, and maybe that they might avoid that part of town for a little while. we might start to think about trauma if they feel that they are identified now as a victim to other people. They feel very threatened. They feel like it's very likely that this is going to happen to them again. That they experience an ongoing sense of terror and fear when they're about this. There's this hypervigilance. They're constantly looking around or perhaps they can't go out anymore.

21:20Agreed. So I would be seeing trauma as the development of trauma responses that are still impacting the person's daily functioning. In the example you just gave, that person might now be traveling, I don't know, 10 minutes, 20 minutes away just to get food because of that fear. And that's where we might be crossing more towards the territory of trauma.

21:40Kimberley Wilson:And if we think about Gabriella's email, the next step on from that, so when does trauma tip into PTSD? So ultimately it's when there are enough trauma responses, when we're thinking about cognitive, emotional behaviour responses, to meet that threshold. So there are four major clusters within a PTSD diagnosis. Intrusion symptoms, avoidance, negative changes to how people think in their mood, and then arousal reactivity. So an individual would have to have trauma responses within all of those four major clusters. When we're thinking about intrusion symptoms, that might be nightmares about the traumatic event.

22:19It might be intrusive memories about the traumatic event where the person feels like they are reliving or re-experiencing that actual traumatic event. When we're thinking about avoidance, this might be avoidance of external reminders of the traumatic event, but it can also be cognitive suppression. And a lot of people will say to me, well, isn't that a good thing that the person isn't thinking about the traumatic event? But that can become quite hard when you need to do emotional processing work. the person needs to be able to tap in to those traumatic events. Third one being negative changes to mood and cognition.

22:51So people can forget significant parts of a traumatic event or people struggle to feel positive emotions. And then arousing reactivity is hypervigilance, the poor sleep, poor concentration, the reckless destructive behaviors, etc.

23:06Kimberley Wilson:Thank you. Now, if you're struggling with trauma, please don't try to manage this on your own. There are people and places you can go to for help and we'll share details of support and resources at the end of the show.

23:25Kimberley Wilson:So for everyone listening, I understand that this might sound like quite a heavy episode and it is, but it's really important. And it's also important to know that there are things that you can do to support yourself. Ron what kinds of things might people be able to do to look after themselves? I would also caveat that with what they can do to support other people as well so if we stick to the person trying to help themselves it goes back to how they listen to their body so being in green spaces, touching grass, being around nature the breath work, the movement there's lots of research showing that that stuff is so effective in regulating the nervous system And for me, that would be quite crucial if you find you're somebody that is constantly having your stress response being activated.

24:15Kimberley Wilson:So you somehow have to find ways to give your body safety signals. Agreed, agreed, agreed. Especially at a time now where we are so exposed to traumatic events, simply through looking at our phones, that the stress response is constantly being activated. So we have to be more mindful to try to regulate it. Would avoiding social media, the news, certain sources of information be something that you would recommend? Absolutely. Absolutely. Yes, and there's a difference between being informed and being shell-shocked and overwhelmed and inundated, flooded with information. Agreed. And the second part is supporting each other.

24:56And it's not about trying to fix people, but it's how are you being present? How are you being consistent to somebody that you know might be struggling with this stuff? how are you validating their experiences and i often tell the people i work with that these are all normal responses to an abnormal situation and of course there are specific